Compression bandages and wet venous ulcers

Our clinicians always want compression bandages on chronic venous ulcers but we seem to get alot of wet ulcers which soak the bandages within the day !!! This means we're forever changing them, anyone got any ideas for helping me to manage this ???


When you say 'clinicians' are you referring to MDs? Maybe you need a wound care consult?

When we get patients from home care and nursing homes, the trend seems to be wet to dry with compression like dsg. In the hospital, we don't use compression dressing, if it is a deep stage two to three, they get hyperbaric treatment. a skinny one to skinny two, we either do wet to dry, or if the wound is crusting, to telfa and try to let it heal air dry.The difference in home and hospital may be huge, but these stage two wounds are usually almost healed before transfer to step down. Just my ICU exp. not home health.

What kind of wounds are you talking about? The only wounds you stage are pressure ulcers. The only wounds you use compression on are venous stasis ulcers. Wet to dry dressing should only be used for debriedment of necrotic tissue. Most current nurses no longer use wet to dry dressings as it is no longer within standards of care as there are many other more appropriate wound treatments out there. But there are still MDs who order this wet to dry for most wounds and wont change the order. You should not let a wound scab over, a dry wound is a dead wound. wound healing needs a warm moist environment.In Home care the patient is up most of the day or sitting with legs dependant and needs compression therapy to control the edema. controling edema is crucial to healing a stasis ulcer. in a hospital environment the patient is in bed so edema is not much of an issue there.

We will usually use some sort of alginate on the wound bed itself under compression dressings. Other options are iodisorb sheets, foams (but in my experience they can cause maceration)or abds depending on the wrap. Skin prep can help protect fragile skin surrounding as will a and d. Need an order for all that though.

Another thing to try under a compression dressing is a composite dressing called extrasorb. it has a contact layer that will keep the periwound skin dry and locks in the drainage. it comes in 2 sizes, a 4x4 and a 8x4 i believe but they work wonderfully on a heavy draining stasis wound, and it can be used under compression.